Case studies | Acute Rheumatic Fever

Describe Osler's nodes

Painful, usually in the pulp of fingers. Caused by immune complex deposition in the microvasculature. Classic in presentation of infective endocarditis.

Describe Roth spots

Are caused by immune complex deposition in the microvasculature like Osler's spots, but in the retinal vasculature. Classic in presentation of infective endocarditis.

What damage can infective endocarditis cause the heart?

With infection progresson-> <font color=""#3db900"">valves become less compliant</font>-> <font color=""#3db900"">congestive heart failure</font> and <font color=""#3db900"">pulmonary edema</font>.<div>Progression into myocardium-> <font color=

How do you diagnose infective endocarditis?

1) Do blood cultures (3, 10mL draws in 24hrs)<div>2) Do an echo (TTE is less sensitive but easier on patient; TEE is more sensitive but more invasive, so only do if strong suspicion)</div><div>3) Modified Duke's criteria for clinical diagnosis</div>

What is mycotic aneurysm and what causes it?

An arterial <font color=""#3db900"">infective endarteritis </font>caused by <font color=""#3db900"">bacterial seeding of a damaged arterial wall </font>(via atherosclerosis). Occurs via direct extension, seeding of the intima, and septic microemboli

The major complication of mycotic aneurysms is <span class=cloze>[...]</span>

The major complication of mycotic aneurysms is <span class=cloze>infections of other sites</span><br>

What is suppurative thrombophlebitis? What causes it?

<font color=""#3db900"">Bacteremia resulting in infected venous wall</font>. Complications include septic pulmonic emboli and metastatic foci of infection. <font color=""#3db900"">Most common cause is S. aureus</font>, but can also be caused by <fon

Bacterial and protazoan causes for myocarditis are rare. What could they be?

<div><b>Bacterial</b></div><font color=""#3db900"">C. diphtheriae</font>: generates toxin that affects the conduction system<div><font color=""#3db900"">Strep pyogenes</font>: causes acute rheumatic fever</div><div><font color=""#3db900"">Lyme disease</f

what comes a more common cause of meningitis as we get to 50yo and above and why

Listeria as we begin to lose T cell function

what type of bacteria is listeri monocytogenes

1) short gram + rod <br><br>2) beta hemolysis <br><br>3) tumbling motility

What are the clinical manifestations of menigitis?

<div>1) Fever</div><div>2) Headache</div><div>3) Meningismus - a triad of headache, photophobia and nuchal rigidity</div><div>4) Cerebral dysfunction (confusion, delirium, lethargy, or coma)</div>

What are the most common causative agents of bacterial menigitis?

S. pneumoniae<div>N. Menigitidis</div><div>H. Influenzae</div><div>L. Monocytogenes</div><div>GBS</div>

What are clinical differences between encephalitis and menigitis?

Encephalitis: Fever and <font color=""#3db900"">abrupt mental status changes</font>. No nuchal rigidity. <font color=""#ff5500"">Lymphocyte </font>dominant<div><br /></div><div>Meningitis: Fever, <font color=""#3db900"">delayed mental status changes</fon

What are common viral cuases of encephalitis?

Herpes (Simplex 1 and 2, varicella zoster)<div>Enterovirus</div><div>Arboviruses (WN, Zika)</div>

What are we looking for on PCR, Antibody, and Serum Serology of the following viruses?<div>Enterovirus, HSV, VZV, WN, Zika</div>

What are the three cardinal symptoms of HUS?

Hemolytic anemia<div>Acute renal failure</div><div>Thrombocytopenia</div>

How do anaerobes enter the blood stream to cause BSI?

Uncommon. Occurs via perforation of bowels or intra abdominal infection

What is the minimum amount of blood needed by the lab to culture?

5ml. Diagnostic yeild increases by 3% for every 1mL of blood drawn.

How much blood for a culture should be drawn from an adult, child, infant, and adult low volume?

What is the process by which blood is cultured?

Draw blood<div>Place in BACTEC blood culture incubator (held for 5 days for bact, 30 for mycob/fungus). Machine updates report every 24hrs unless bottle becomes (+)-> bacteria producing CO2-> florescence</div><div>After incubation, cultures plated,

What are the most common gram (+) causes of central line associated blood stream infections (CLABSI)? Most common fungal cause?

Staph Epidermidis (coag neg staph)<div><br /></div><div>Staph Aureus</div><div><br /></div><div>Enterococci</div><div><br /></div><div>Fungal: Candida</div>

How does germ tube used to identify candida albicans

Provides growth factors and when grows will look like lollipops on a stick. C albicans is germ tube (+)